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General NPI Number Information
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NPI Number | 1386068294
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Entity Type | Organization
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Legal Business Name | SENTRY SURGICAL ASSISTANTS
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 12127 WORTHAM LANDING DR
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City | HOUSTON
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State | TX
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Zip | 77065-5212
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Country | US
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Telephone | 409-771-2237
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Fax |
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Provider Business Mailing Address
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Address Line | 12127 WORTHAM LANDING DR
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City | HOUSTON
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State | TX
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Zip | 77065-5212
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Country | US
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Telephone | 409-771-2237
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT CERTIFIED
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Name | MR. JUAN CARLOS DE LEON
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Credential | SA-C
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Telephone | 409-771-2237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 09-136
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License Number State | TX
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